IN-DEPTH: COLIC


Additionally, Nath el al found elevations in CTnI on presentation in 36% of horses with strangulating lesions and 47% of horses with inflammatory le- sions.22 Of the non-survivors, 50% had elevated CTnI concentrations compared with only 22% of sur- vivors. Because endotoxin can lead to an increase in CTnI concentrations, it is likely that the horses with elevated CTnI were those with higher levels of endotoxin exposure. Additionally, CTnI has a very short half-life and quickly returns to normal once the initial insult is resolved.24


Abdominocentesis


An analysis of peritoneal fluid can add critical infor- mation for cases that are not straightfor- ward. Peritoneal fluid analysis has been described in colic multiple times in the last 30 years. Classi- cally, the evaluation is focused on markers of inflam- mation. Matthews et al identified color and protein values as the two most important variables distin- guishing surgical cases from medical cases.25 Se- rosanguinous fluid had a 98% positive predictive value for the need of surgery, while a normal color had an 89% negative predictive value for the need of surgery. Total protein was less predictive but still better than total nucleated cell counts. When con- sidered as a whole, any sample with one abnormal- ity had a 79% positive predictive value for surgery while a completely normal value had an 89% nega- tive predictive value for surgery. Freden et al found less value in single variables with the excep- tion of abdominal fluid color.26 A study of 100 ab- dominal fluid samples also found less value in the total nucleated cell count, although the count was higher in nonsurvivors.27 The author suggests a differential of the cells may be more useful in pre- dicting outcome. More recently, Peloso and Cohen found that increasing peritoneal lactate values over time were consistent with strangulating lesions.12


5. Conclusion


Investigations continue to improve our understand- ing of clinicopathologic changes associated with acute abdominal crisis and in the hope of identifying that single measurement that may clearly divide surgical from medical cases and survivors from non- survivors. Because of the complexities associated with the response to inflammation, abnormalities associated with poor oxygen delivery, and regional differences in diseases, a single value is unlikely to be found. However, the use of serial measurements shows promise in improving the prognostic value for cases, monitoring the effects of therapy, and identi- fying surgical lesions more quickly.


Acknowledgments


Conflict of Interest The Author declares no conflicts of interest.


References


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2. Gay CC, Carter J, McCarthy M, et al. The value of arterial blood pressure measurement in assessing the prognosis in equine colic. Equine Vet J 1977;9(4):202–204.


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4. Bertin FR, Reising A, et al. Clinical and clinicopathological factors associated with survival in 44 horses with equine neorickettsiosis (Potomac horse fever). J Vet Intern Med 2013;27(6):1528–1534.


5. Groover ES, Woolums AR, Cole DJ, et al. Risk factors asso- ciated with renal insufficiency in horses with primary gastro- intestinal disease: 26 cases (2000–2003). J Am Vet Med Assoc 2006;228(4):572–577.


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9. Gardner RB, Nydam DV, Mohammed HO, et al. Serum gamma glutamyl transferase activity in horses with right or left dorsal displacements of the large colon. J Vet Intern Med 2005;19(5):761–764.


10. Davis JL, Blikslager AT, Catto K, et al. A retrospective analysis of hepatic injury in horses with proximal enteritis (1984–2002). J Vet Intern Med 2003;17(6):896–901.


11. Saulez MN, Cebra CK, Tornquist SJ. The diagnostic and prognostic value of alkaline phosphatase activity in serum and peritoneal fluid from horses with acute colic. J Vet Intern Med 2004;18(4):564–567.


12. Peloso JG, Cohen ND. Use of serial measurements of peri- toneal fluid lactate concentration to identify strangulating intestinal lesions in referred horses with signs of colic. JAm Vet Med Assoc 2012;240(10):1208–1217.


13. Tennent-Brown BS. Interpreting lactate measurement in critically ill horses: diagnosis, treatment, and progno- sis. Compend Contin Educ Vet 2012;34(1):E2.


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17. Johnston K, Holcombe SJ, Hauptman JG. Plasma lactate as a predictor of colonic viability and survival after 360 degrees volvulus of the ascending colon in horses. Vet Surg 2007; 36(6):563–567.


18. Delesalle C, Dewulf J, Lefebvre RA, et al. Determination of lactate concentrations in blood plasma and peritoneal fluid in horses with colic by an Accusport analyzer. J Vet Intern Med 2007;21(2):293–301.


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21. Kraus MS, Jesty SA, Gelzer AR, et al. Measurement of plasma cardiac troponin I concentration by use of a point-of-


AAEP PROCEEDINGS  Vol. 60  2014 211


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